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NPI Code Detail

MEDICARE: HEIDI WETTELS D.D.S

MEDICARE:   HEIDI  WETTELS  D.D.S
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry045584NY

General Provider Information

NPI Number : 1417139551
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI WETTELS D.D.S
Provider Business Mailing Address
First Line : 268 TINKER ST
Second Line :
City : WOODSTOCK
State : NY
Zip : 12498-1129
Country : US
Telephone Number : 845-679-6083
Fax Number :
Provider Business Practice Location Address
First Line : 268 TINKER ST
Second Line :
City : WOODSTOCK
State : NY
Zip : 12498-1129
Country : US
Telephone Number : 845-679-6083
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2007
Last Update Date : 09/29/2010

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Directions to “ HEIDI WETTELS D.D.S” Practice Location

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